Every sixth patient suffers withdrawal symptoms when stopping antidepressants

Magazine Lancet Psychiatry this week publishes the first meta-analysis of the incidence of antidepressant withdrawal symptoms. The study included data from more than 20,000 patients with a mean age of 45 years and 72% women, which were collected from 79 randomized controlled trials and observational studies.

A new study by researchers from the German universities of Berlin and Cologne highlights that these symptoms are much more severe. less common than previously thought. Specifically, the results show that the risk of a person stopping taking antidepressants experiencing effects such as dizziness, headache, nausea, insomnia and irritability is 15% (equivalent to one in six or seven people).

According to previous estimates, withdrawal syndrome After discontinuation of this drug, it affected 56% of patients, and almost half of the cases were classified as serious. However, the authors of the new paper note that much of this evidence is based on observational studies, which cannot reliably determine cause and effect.

Randomized controlled trials distinguish between drug-induced symptoms and “non-specific” symptoms that may be due to patient expectations (nocebo effect).

On the other hand, randomized controlled trials, in which 50% of study participants receive a drug and the remaining 50% receive a placebo, are more confident in distinguishing between symptoms caused directly by the drugs and “non-specific” ones, which may be due to the expectations of patients or doctors (nocebo effect).

According to what he told SINC Christopher Bethgeprofessor of psychiatry at the University of Cologne and the paper’s main co-author, the study focused not “on isolated effects, but on the presence of any symptom, whatever it may be.”

Incidence rates

“We hope that our results will serve to provide relevant information to medical personnel without causing unnecessary worry. Like all medications, antidepressants have important benefits, but they also carry risks, including withdrawal symptoms,” he emphasizes.

The purpose of this study was to review all available evidence to establish the likely incidence of symptoms directly caused by discontinuation of antidepressant use, the likelihood of serious consequences, and differences between different types of medications.

Stepwise dose reduction

Health guidelines recommend gradually tapering your antidepressant dose rather than abruptly stopping or skipping doses, which can cause withdrawal symptoms.

Analysis published in Lancet Psychiatry shows that a third (31%) of people who stopped taking antidepressants experienced at least one symptom, including dizziness, headache, nausea, insomnia and irritability. Serious consequences were observed in approximately 3% (one in 35).

Stop taking imipramine (Tofranil), venlafaxine/desvenlafaxine, reuptake of serotonin and norepinephrine and paroxetine (Seroxat), a serotonin reuptake agent, has been associated with an increased risk of severe symptoms compared with other antidepressants.

Refund applies to neurotransmitter reabsorption and other substances after they have been released into the synapse, and has direct implications for the modulation of nervous system function.

As for strategies to reduce the risk of withdrawal symptoms when stopping these medications, “we recommend tapering off antidepressants for three months, or even longer if time is not an issue,” Bethge tells SYNC Agency.

We recommend stopping taking antidepressants for three months or even longer. If withdrawal symptoms are very persistent, you may want to switch to drops rather than tablets to achieve a more gradual taper.

Christopher Bethge
— Co-author of the study (University of Cologne)

The co-author added: “If withdrawal symptoms are very persistent, drops may be prescribed rather than tablets to allow for a more gradual taper. If you are taking serotonin reuptake drugs, switch to fluoxetinewhat’s happened a selective reuptake inhibitor may be a good option for dose modulation.”

The team also found that 17% of people experienced symptoms after stopping placebo. “A possible explanation is greater awareness of increased anxiety and depression when stopping a seemingly beneficial medication,” the expert says.

The authors note some work restrictions, as the studies included in the systematic review and meta-analysis used different methodologies. Additionally, a problem with all studies of the effects of stopping medication is the possibility of a return of depression, which can be interpreted as a withdrawal syndrome. The article does not include analysis of several commonly used antidepressants, such as mirtazapine, bupropion, or amitriptyline.

Spain is the third country in the EU with the highest consumption of antidepressants, which increased by 18% at community level between 2019 and 2022, coinciding with COVID-19 pandemicThis is evidenced by data from the Organization for Economic Co-operation and Development (OECD).

Link: J. Bethge, J. Hensler and others — “Incidence of antidepressant withdrawal symptoms: a systematic review and meta-analysis.” Magazine Lancet Psychiatry, 2004 | DOI: 10.1016/С2215-0366(24)00133-0.